The College of Physicians and Surgeons of Ontario (CPSO) is conducting a regularly scheduled review, as it does every five years, of its internal human-rights code and is being pressured to modify the sections regarding denying services based on conscience.
“A lot of physicians feel strongly that they want these conscience rights protected,” said Moira McQueen, executive director of the Canadian Catholic Bioethics Institute. “We have been encouraging people... to write to CPSO to say keep the policy the way it is so that physicians do not have to prescribe something that they think is morally unacceptable. It usually is about contraception and abortion ... neither one of those are truly medical emergencies.”
CPSO encouraged public feedback on its web site until Aug. 5 as an initial step in the process.
“The feedback obtained during this consultation will be carefully reviewed and used to create a draft policy,” said Prithi Yelaja, a spokesperson for the college. “While it may not be possible to ensure that every comment or suggested edit will be incorporated into the revised policy, all comments will be carefully considered.”
Yelaja said following this “preliminary stage,” CPSO will draft a revised policy. Stakeholders will then be asked to review and comment on the draft before a final version is put forward for consideration. The process is expected to last into 2015.
The college’s code affords doctors the right to deny a non-emergency prescription, referral or procedure that they object to morally. This specific section of the policy has fuelled controversy.
Earlier this year an Ottawa woman, 25-year-old Kate Desjardins, went public with her dissatisfaction when she received a letter from a walk-in clinic stating that “for reasons of my own medical judgment as well as professional ethical concerns and religious values, I only provide one form of birth control — Natural Family Planning.” All three doctors on staff at the clinic — Edmond Kyrillos, Agnes Tanguay and Rene Leiva — are reported to have been circulating this letter. When contacted by The Register, Leiva declined to comment on the advice of his lawyer following a series of “bad press” after Desjardins publicized the clinic’s letter.
“A lot of people think that physicians should just prescribe what the person is actually asking for and the personal belief or opinion of the physician shouldn’t matter at all,” said McQueen. “That really compromises the physician.”
Retired physician and practising Catholic Gillian Gilchrist, who spent much of her career working in palliative care before transitioning into pain management, disagrees with stripping doctors of their moral beliefs at work.
“It is going to make it very difficult for them,” said Gilchrist, who retired in the mid-1990s after four decades of practising medicine. “I think this is dreadful. Obviously everybody has a point of view and I think that everybody in Canada should be able to exercise that point of view.”
If doctors are stripped of their right to deny patients what they are asking for Gilchrist fears it will only be a matter of time before controversial practices like euthanasia come to Ontario — something she said few physicians want to perform.
“The whole euthanasia business ... I am frightened about it,” she said. “It is taking lives and I don’t see that doctors should be put in the position to do that, that is not our training. A lot of us feel that we were trained to save lives and not to kill people.”
Both Gilchrist and McQueen said that while much of the discussion has focused on religion and controversial procedures, the implications of making this change extend beyond what the Bible says is right and wrong.
“It isn’t necessarily a Catholic issue ... it applies to all of the doctors in Ontario,” said McQueen. “Physicians have to be able to say in some situations I don’t think this is the right thing to do. Sometimes what the patient has asked for is not actually in their best interest even though the patient themself might think it is.
“If they really think it is the wrong thing for the patient then they shouldn’t be forced to do it.”
She used the example of a person addicted to painkillers asking for a prescription of their choice to ease withdrawal symptoms, one of which is physical pain. And while McQueen noted this is just a hypothetical outcome, it is still worth considering.
“If the (CPSO’s) human-rights code were altered so that physicians had no protection, it is very hard to say what exactly would happen, but I think a lot of physicians would feel very threatened and I think it would be hard for some of them to continue practising,” she said. “That is why it is so important that the College of Physicians get feedback.”